Varicose veins and Ulcers Flashcards
What are varicose veins?
Tortuous, dilated veins
What is the pathology of varicose veins?
Incompetent valves lead to back flow of venous blood leading pooling to venous hypertension causing dilation ov the vessels
What is the aetiology of varicose veins?
Mostly idiopathic
What are the four major risk factors for varicose veins?
- Prolonged standing
- Obesity
- Pregnancy
- Family history
How are varicose veins confirmed?
Duplex ultrasound
How do varicose veins present?
- Visibly dilated tortuous veins
- Varicosities over the courses of the great and small saphenous veins
- Can be painful, itchy and swollen
- Can show symptoms of venous insufficiency
- Can have saphena varix
What are some symptoms ov venous insufficiency?
- Oedema
- Thrombophlebitis
- Ulcers
- Lipodermatosclerosis
- Atrophie Blanche
What is saphena varix?
A varicose vein in the groin with a cough reflex
In what ways can varicose veins be managed?
- Surgically
- Non-surgically
When is surgical management used for varicose veins?
In non-cosmetic cases where the problem is due to symptomatic skin changes or ulceration
How are varicose veins managed non-surgically?
- Patient education
- Compression stockings
- 4 layer bandaging for venous ulceration
How can patients with varicose veins be educated to improve their condition?
Promote less standing and more walking
How can varicose veins be managed surgically?
- Vein ligation, stripping and avulsion
- Foam sclerotherapy
- Thermal ablation
What happens to varicose veins over time?
They will get progressively worse
What does worsening of varicose veins over time carry increased risk of?
- Thrombophlebitis
- Ulceration
What are the three main types of skin ulcers?
- Venous
- Neuropathic
- Arterial
Which type of skin ulcers are most common?
Venous ulcers
How do venous ulcers appear?
Shallow with a granulated base
What causes venous ulcers?
Venous insufficiency due to incompetent valves leading to pooling of blood and impaired gas exchange
How do venous ulcers present?
- Painful
- Worse at the end of the day
- Dry and itchy surrounding skin
- Often have varicose veins and associated symptoms
How are venous ulcers investigated?
- Duplex ultrasound
- Normal ABPI results
How are venous ulcers managed?
- Compression bandages (must exclude arterial insufficiency)
- Improve flow by less standing and more walking
Where are venous ulcers most common?
Gaiter area of the leg (lower shin and ankles)
When do neuropathic ulcers occur?
Damaged skin left unnoticed due to neuropathy caused by DM/B12 deficiency
